The Queensland Health Rural Generalist Pathway: Demonstrable Impacts on Rural Medical Workforce

Tarun Sen Gupta, Dan Manahan, Denis Lennox, Natalie Taylor, Ruth Stewart, Ruth Stewart,

James Telfer, Leanne Browning, Derek Holroyd, Deanne Bond

Overview• Operation of the pathway• Evaluation of the pathway• Impact of the pathway

What isRural Generalist Medicine?

Rural Generalist Medicine has been recognised in Queensland as a medical specialty since May 2008. A Rural Generalist is a rural medical practitioner who provides:

• hospital and community-based primary medical practice; and

• hospital-based secondary medical practice, including advanced skills in emergency medicine, Indigenous health, internal medicine, mental health, paediatrics, obstetrics, surgery or anaesthetics; and

• hospital and community-based public health practice.

What is the Rural Generalist Pathway?

The Rural Generalist Pathway (RGP) provides guidance and support to medical officers seeking a career in Rural Generalist Medicine.

Initiated in 2007 to: “develop and sustain an integrated service and training program to form a career pathway supplying the Rural Generalist workforce that the bush needs”.

(Roma Agreement, Queensland, Australia, October 2005)

Aim of the Rural Generalist Pathway

• to provide a premier health career pathway to rural practice;

• increase the supply of health professionals fit for practice in rural and remote Queensland;

• provide appropriate preparation, training and support; and

• to assist in filling vacant positions in rural health facilities.

2013 Ernst and Young report

Four transformational pillars:

1.Recognition of profession2.Value of practice3.Pathway4.Workforce redesign

•Trainee feedback•Cost analysis•Efficiency

QRGP conception, implementation and progress.

EY Key FindingsTrainee feedback•Supported pathway•Rural work•Fast track•Variety•Reputation

Efficiency•Implementation phase•Shift to workforce planning•Mx of QRGP – HHS

Cost analysis•$5315 / trainee / year•$23,800 extra / year for SMO•120% ROI•Meeting critical vacancy need

• Provided an exceptionally high quality training program valued by trainees and graduates;

• Reflected the commitment of senior clinicians to the program through high quality supervision and support;

• Operated at an efficient level, with improvements to be made in: information system management, policy / process consolidation and key stakeholder communication protocols;

• Demonstrated a high degree of flexibility and responsiveness to trainee needs;

The EY evaluation concluded that the Rural Generalist Pathway has:

• Yet to realise its potential to support workforce planning activities undertaken by State Hospital and Health Services;

• Met the needs of local communities through the reduction of critical medical vacancies, enabled health services to expand service delivery and is making services more accessible and affordable to local residents; and

• Represented value for money with a return on investment ratio conservatively estimated to be in the vicinity of 1:2.

The EY evaluation conclusions (cont)

• early immersion in rural medicine during the prevocational years (first two postgraduate years);

• due recognition being given to the profession by Queensland Health (associated industrial and remuneration packages);

• the fast track nature of the program - attractive to trainees but also addresses the workforce needs of rural communities in a timely fashion;

• the quality of the training and supervision offered;

• the effective quarantining of training placements in rural locations and the preference given to Rural Generalist Medicine trainees;

• career opportunities presented throughout the training period, albeit currently perceived as limited to the State of Queensland.

Critical Success Factors

Impact: training numbersPostgraduate Year

Current trainee numbers (2015)

PGY1 53

PGY2 46PGY3 36

PGY4 32

PGY5 23PGY6+ 47

TOTAL 237

A total of 48 trainees have completed Fellowship of ACRRM and/or RACGP with 30 practising in rural and remote Queensland, 5 in rural parts of other States / Territories and one in New Zealand.

Attrition to date: 86 since 2008 with the main reasons for withdrawing being pursuit of specialty training and relocation to outside of the State of Queensland.

Locations in Qld which have hospitals and may attract RGs

Prevoc and AST

13

Advanced skills training numbers

Trainees with multiple advanced skills

Impact: locallyMeeting critical vacancy need (E/Y)Service redesign….Longreach / Cooktown / Emerald / Mt Isa / Stanthorpe

•Mt Isa: 0 -> 9 Registrars 2010 – 15•Longreach / Central West: Locums > $7M pa to $1M

Retention in vocational training post

Future challenges

• Additional Intern / Junior Medical Officer training positions (already increased from 30 (2007) to 80 positions in 2015);

• Expanding Advanced Skills Training capacity;

• Strengthening private practice training models;

• Implementation of innovative training solutions eg. ‘Prevocational Integrated Extended Rural Clinical Experience’ (PIERCE)’

http://www.health.qld.gov.au/ruralgeneralist/content/greatadventure.asp

Web: http://www.health.qld.gov.au/ruralgeneralist/

Email: rural_generalist@health.qld.gov.au

Thank you

Conference RecommendationEducational programs should define their outcomes,

evaluate these independently and report and disseminate evaluation results publically in the interests

of sharing good practice.

Outcomes should include an emphasis on impacts such as trainee recruitment and retention, workforce supply and retention and should include other measures like

trainee, supervisor and employer satisfaction as well as measures of education process in terms of value for

money and of success in meeting objectives.

PGYear

Rural GeneralistPathway

Queensland Hospital &Health ServiceAppointment

Salary Status

AustralianGeneralPracticeTraining

RVTS*Australian Collegeof Rural & RemoteMedicine (ACRRM)

Royal AustralianCollege of General

Practitioners(RACGP)

1Prevocational

Training

Intern Level 1 Apply - - -

2 Junior House Officer (JHO) Level 2 Yr 1 - Core Clinical

Training Hospital Training

3Advanced

Specialised/Skills Training

Registrar / PrincipalHouse Officer (PHO) Level 4 Yr 2 Apply

Advanced Specialised

Training

Advanced SkillsTraining

4

VocationalTraining

Senior Medical Officer (SMO) (Provisional

Fellow)

Medical Officer with Right to Private Practice

(MORPP)

Level 13

Yr 3 Yr 1Primary Rural &

RemoteTraining

GP Terms

5 Yr 4 Yr 2Primary Rural &

RemoteTraining

GP Terms

6

ContinuingProfessionalDevelopment

SMOMedical Superintendent

With Right to Private Practice (MSRPP)

MORPPVisiting Medical Officer

(Advanced Practice)

Level 18 –25

- -

FACRRMInc. Advanced

SpecialisedSkills Certification

FRACGP/FARGPInc. Advanced Skills

Certification+

Certified Women’sHealth

7 - -

8 - -

Rural Generalist Pathway – Training Progression Table

*RVTS – Remote Vocational Training Scheme